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The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: ("novel coronavirus" Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.

The incidence of inflammatory bowel diseases (IBD) - Crohn's disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine.

Squamous cell carcinoma (SCC) of the lower lip is a deadly nonmelanoma skin cancer. Its precursor, a distinctive cutaneous neoplasia analogous to cervical dysplasia, is known by the confusing term actinic cheilitis. Solar cheilosis (SC) is a more appropriate designation. It represents incipient SCC in situ. SC is widely recognized as an ultraviolet light-induced precancer of the lower lip that is typically seen in light-skinned individuals and others with poorly pigmented lower lips. Lip SCC is one of the most common malignancies of the oral cavity. SCC is much more likely to metastasize from the lip than cutaneous surfaces, with a 5-year overall survival rate of less than 75%. SC results from long-term exposure to ultraviolet radiation. The occurrence of SC is dose-dependent and is influenced by the patient's solar exposure, age, genetic predisposition, geographic latitude of residence, occupation, leisure activities, and use of lip protective agents. Molecular abnormalities of SC are similar to those of actinic keratosis and facilitate the evolution to SCC. A high degree of clinical suspicion should be maintained, given the malignant nature of this condition. Ulceration and nodularity often indicate progression to SCC. We performed a Medline and Google Scholar search for all articles related to actinic cheilitis, actinic cheilosis, SC, actinic keratosis, solar keratosis, premalignant oral disease, and lip SCC, and have also evaluated many other articles and book chapters. One hundred forty-two peer-reviewed articles were identified as being of particular value. Pertinent facts were selected and analyzed., (Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Mast cells (MCs) display a diversity of roles that may contribute to the stromal microenvironment alterations during tumor progression. The aim of this study was to investigate MC populations expressing tryptase and c-kit in lip squamous cell carcinoma (lip SCC) (n=37), actinic cheilitis (AC) (n=15) and normal lip mucosa (control) (n=6), as well as their relationship with microscopic parameters (collagen degeneration, elastin changes, angiogenesis and proliferative index). Tryptase, c-kit, CD31 and Ki-67 expressions were analyzed by means of immunohistochemistry and collagen and elastic fibers were visualized with Picrosirus and Verhoeff's stain, respectively. The numbers of tryptase+ MC were significantly higher in lip SCC when compared with control (P=0.01), while a similar density of these cells was observed in AC and lip SCC (P=0.09). The density of c-kit+ MC was similar in all groups examined (P=0.65). MC migration (c-kit+/Tryptase+ relationship) was 69% in lip SCC, 60% in AC and 100% in control. The number of CD31+ blood vessels was significantly higher in the lip SCC when compared with control and AC (P<0.01). The increase of MCs and angiogenesis in lip SCC may reflect an important modification in the tumor microenvironment during squamous photo-carcinogenesis.

Cheilitis glandularis (CG), is a rare inflammatory minor salivary gland disease affecting the lower lip. The hallmarks of which include progressive enlargement and eversion of the lower labial mucosa resulting in the obliteration of the mucosal-vermillion interface. A case is presented of a 47-year-old HIV-infected woman who initially manifested clinical features of CG with a typical histopathology picture of a non-specific sialadenitis while a second biopsy performed six months later revealed well differentiated squamous cell carcinoma (SCC). She is symptom free one year following excision and radiotherapy treatment.

Exfoliative cheilitis, one of a spectrum of diseases that affect the vermilion border of the lips, is uncommon and has no known cause. However, factors such as stress and some psychiatric conditions are associated with the onset of the disease. This condition is disabling because esthetics and normal functions such as eating, speaking and smiling are compromised. The lack of specific treatment makes exfoliative cheilitis a chronic disease that radically affects a person"s life. This report attempts to further investigate the clinical course of the disease and provides detailed illustrations of the cyclical nature of the disease.

Objective: An analysis is made of the etiologic factors underlying actinic cheilitis and of the results obtained following surgical treatment of the disease in a series of 54 patients (32 males and 22 females)., Study Design: The case history was evaluated, along with the triggering factors, histopathological pattern and recurrence of lesions. A cold scalpel vermilionectomy was performed in 41 patients, followed by primary closure of the defect using an oral mucosal flap. The remaining 13 patients were subjected to carbon dioxide laser vermilion ablation., Results: The history of the patients revealed liver disease associated to alcohol consumption in 35.2% of cases and tobacco smoking in 77.8%. As regards solar exposure, 53.1% of the men referred open-air professional activities, while 100% of the women presented important solar exposure. The most frequent clinical manifestations were bleeding and the presence of leukoplakia patches; pain was reported in only 16% of cases. Over 40% of the patients were asymptomatic. Following treatment, and after a follow-up period of at least 6 months, 90.7% of the subjects showed complete healing. Of the 5 patients reoperated upon, four healed and one evolved towards squamous cell carcinoma., Conclusion: Vermilionectomy is the recommended treatment for actinic cheilitis, using either a cold scalpel or carbon dioxide laser. A histological study of the lesion is indicated in all cases to secure early detection of possible malignization. The control of the possible etiologic factors is also essential.

Functional activity of minor salivary glands is studied in 289 children, 52 of these without signs of cheilitis and 237 with allergic cheilitis at different stages. Three variants of secretion are distinguished: fast, medium, and slow. The ratio of these variants changed in exacerbation of disease in comparison with that in health or remission. The activity of the glands depends on clinical manifestations of cheilitis. Changes in the activity of minor salivary glands determine the clinical picture, localization, and type of involvement in cheilitis.

Vascular permeability was significantly increased in the incisor pulp and skin of the lower lip in the rat after antidromic electrical stimulation of the inferior alveolar nerve, and this response was significantly inhibited by a substance-P antagonist. The content of substance P in the pulp and lip was also increased after stimulation. The permeability response was reduced by aspirin and bradykinin antagonists (both B1- and B2-receptor types) in the pulp and lip, indicating that prostaglandins and bradykinin may be involved. Mepyramine and methysergide inhibited the vascular response in the lip but not the pulp; the roles of histamine and serotonin differ in the two tissues. Injection of substance P into the incisor pulp and the lip skin caused dye leakage. This response was inhibited by pretreatment with compound 48/80 in the lip but not the pulp. Lip histamine content was decreased significantly after antidromic stimulation of the inferior alveolar nerve and pretreatment with compound 48/80, but was not changed in the pulp. The results suggest that substance P in the lip, after being released from the peripheral sensory-nerve endings, may act on the vascular system via histamine release from mast cells; but in the pulp may cause vascular response directly because of the scarcity of mast cells.

A physiological role of substance P (SP) in inflammatory reaction was examined in the rat incisor pulp and inferior lip. SP content in pulps and lips significantly increased after antidromic stimulation of the inferior alveolar nerve. Following the same stimulation, vascular permeability also increased significantly in pulps and lips, and this permeability response was significantly inhibited by an SP-antagonist. Morphine reduced the permeability response to antidromic stimulation in pulps but had no effect in lips. N-methyl levallorphan (a peripherally selective narcotic antagonist) prevented the morphine-induced reduction, and was more potent than naloxone. Morphine caused a marked increase of SP content in pulps following antidromic stimulation of the inferior alveolar nerve but failed in lips. These suggest a possibility that a peripheral SP release-suppressive mechanism by opiates may exist in pulps but not in lips. The permeability response to antidromic stimulation was also reduced by aspirin and a bradykinin antagonist in both of the tissues, indicating that prostaglandin and bradykinin may be related to this response. Since mepyramine and methysergide inhibited the permeability response in lips but were inactive in pulps, there is a difference in participation of histamine and serotonin between the two tissues. SP injection into the dental pulp and lip induced dye leakage. This response was inhibited by compound 48/80 pretreatment in lips whereas it was resistant in pulps. Histamine content in lips decreased significantly after antidromic stimulation and compound 48/80 pretreatment, but it was not changed in pulps. The present results suggest that in lips after being released from the peripheral sensory nerve endings SP may act on vascular system through histamine release from mast cells, while in pulps SP may directly cause vascular response because mast cells may be few or not exist.